<!--
  ========================LICENSE_START=================================
  screenit-web
  %%
  Copyright (C) 2012 - 2020 Facilitaire Samenwerking Bevolkingsonderzoek
  %%
  This program is free software: you can redistribute it and/or modify
  it under the terms of the GNU Affero General Public License as published by
  the Free Software Foundation, either version 3 of the License, or
  (at your option) any later version.
  
  This program is distributed in the hope that it will be useful,
  but WITHOUT ANY WARRANTY; without even the implied warranty of
  MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  GNU General Public License for more details.
  
  You should have received a copy of the GNU Affero General Public License
  along with this program.  If not, see <http://www.gnu.org/licenses/>.
  =========================LICENSE_END==================================
  -->
<html xmlns:wicket>
<wicket:extend>
    <div class="row-fluid">
        <div class="span12">
            <h1 class="pageTitle" wicket:id="label">Medewerkergegevens</h1>
        </div>
    </div>
    <div class="row-fluid form-horizontal">
        <div wicket:id="dialog"></div>
        <fieldset>
            <wicket:container wicket:id="paspoort"/>

            <form wicket:id="medewerkerForm">
                <fieldset>
                    <div class="row-fluid">
                        <div class="span12">
                            <legend>Naam</legend>
                        </div>
                    </div>
                    <div class="row-fluid">
                        <div class="span6">
                            <div class="control-group">
                                <label class="control-label">Achternaam</label>
                                <div class="controls">
                                    <input class="input-large" type="text" wicket:id="achternaam">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Tussenvoegsel</label>
                                <div class="controls">
                                    <input class="input-mini" type="text" wicket:id="tussenvoegsel">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Voorletter(s)</label>
                                <div class="controls">
                                    <input class="input-mini" type="text" wicket:id="voorletters">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Voornaam</label>
                                <div class="controls">
                                    <input class="input-large" type="text" wicket:id="voornaam">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Geboortedatum</label>
                                <div class="controls">
                                    <div class="input-append">
                                        <input wicket:id="geboortedatum" type="text" maxlength="10"
                                               class="input-small datum">
                                    </div>
                                </div>
                            </div>
                        </div>
                        <div class="span6">
                            <div class="control-group">
                                <label class="control-label">Aanhef</label>
                                <div class="controls">
                                    <select wicket:id="aanhef">
                                        <option selected disabled>- Maak een keuze -</option>
                                        <option>Dhr.</option>
                                        <option>Mevr.</option>
                                    </select>
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Titel</label>
                                <div class="controls">
                                    <select wicket:id="titel">
                                        <option selected disabled>- Maak een keuze -</option>
                                        <option>Dr.</option>
                                        <option>Drs.</option>
                                        <option>Ing.</option>
                                        <option>Ir.</option>
                                        <option>Mr.</option>
                                        <option>Prof.</option>
                                    </select>
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Functie</label>
                                <div class="controls">
                                    <select wicket:id="functie">
                                        <option disabled>- Maak een keuze -</option>
                                        <option>Endoscopist</option>
                                        <option>Patholoog</option>
                                        <option>Radioloog</option>
                                        <option selected>MDL-arts</option>
                                    </select>
                                </div>
                            </div>
                            <div class="control-group">
                                 <label class="control-label">Handtekening (Radioloog)</label>
                                 <div class="controls">
                                     <wicket:container wicket:id="handtekening"></wicket:container>
                                 </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Ondertekenaar (Radioloog)</label>

                                <div class="controls">
                                    <textarea rows="3" style="width: 90%;" wicket:id="ondertekenaar"/>
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label" wicket:id="bigNummerLabel">BIG
                                    nr.</label>
                                <div class="controls">
                                    <input wicket:id="bignummer" class="input-small" type="text"/>
                                </div>
                            </div>
                            <div class="control-group">
                                <label for="zorgverlener" class="control-label">Medewerker
                                    is zorgverlener</label>
                                <div class="controls">
                                    <input class="input-large" type="checkbox"
                                           wicket:id="zorgverlener" id="zorgverlener">
                                </div>
                            </div>
                        </div>
                    </div>
                </fieldset>

                <fieldset>
                    <div class="row-fluid">
                        <div class="span12">
                            <legend>Contactgegevens</legend>
                        </div>
                    </div>
                    <div class="row-fluid">
                        <div class="span6">
                            <div class="control-group">
                                <label class="control-label">Telefoonnummer werk</label>
                                <div class="controls">
                                    <input class="input-large" type="text"
                                           wicket:id="telefoonnummerwerk">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Telefoonnummer priv&eacute;</label>
                                <div class="controls">
                                    <input class="input-large" type="text"
                                           wicket:id="telefoonnummerprive">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Telefoonnummer extra</label>
                                <div class="controls">
                                    <input class="input-large" type="text"
                                           wicket:id="telefoonnummerextra">
                                </div>
                            </div>
                        </div>
                        <div class="span6">
                            <div class="control-group">
                                <label class="control-label">E-mailadres</label>
                                <div class="controls">
                                    <input class="input-large" type="text" wicket:id="emailextra">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Woonplaats</label>
                                <div class="controls">
                                    <input class="input-large" type="text"
                                           wicket:id="adressen[0].plaats">
                                </div>
                            </div>
                        </div>
                    </div>
                </fieldset>
                <fieldset>
                    <div class="row-fluid">
                        <div class="span12">
                            <legend>Aanmeldgegevens</legend>
                        </div>
                    </div>
                    <div class="row-fluid">
                        <div class="span6">
                            <div class="control-group">
                                <label class="control-label">Inlog methode</label>
                                <div class="controls" wicket:id="inlogMethodeContainer">
                                    <select wicket:id="inlogMethode"></select>
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Gebruikersnaam</label>
                                <div class="controls">
                                    <input wicket:id="gebruikersnaam" type="text" value="gebruikersnaam">
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Medewerkercode</label>
                                <div class="controls">
                                    <input wicket:id="medewerkercode" type="text" readonly="true">
                                </div>
                            </div>
                            <wicket:enclosure child="blokkeerContainer">
                                <div class="control-group" wicket:id="blokkeerContainer">
                                    <label class="control-label">Blokkeer account</label>
                                    <div class="controls">
                                        <input wicket:id="disabledOfGeblokkeerd" type="checkbox">
                                    </div>
                                </div>
                            </wicket:enclosure>
                        </div>
                        <div class="span6">
                            <div class="control-group">
                                <button wicket:id="resetWachtwoord" class="btn">Reset
                                    wachtwoord
                                </button>
                            </div>
                            <div class="control-group">
                                <button wicket:id="changeWachtwoord" class="btn">Wachtwoord
                                    wijzigen
                                </button>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Actief vanaf</label>
                                <div class="controls">
                                    <div class="input-append">
                                        <input wicket:id="actiefVanaf" type="text" maxlength="10" class="input-small datum">
                                        <a href="javascript:void(0);" class="btn" onclick="$(this).prev().datepicker('show');">
                                            <i class="icon-calendar"/>
                                        </a>
                                    </div>
                                </div>
                            </div>
                            <div class="control-group">
                                <label class="control-label">Actief tot en met</label>
                                <div class="controls">
                                    <div class="input-append">
                                        <input wicket:id="actiefTotEnMet" type="text" maxlength="10" class="input-small datum">
                                        <a href="javascript:void(0);" class="btn" onclick="$(this).prev().datepicker('show');">
                                            <i class="icon-calendar"/>
                                        </a>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                </fieldset>

                <fieldset wicket:id="uzi-container">
                    <div class="row-fluid">
                        <div class="span12">
                            <legend>UZI-pas</legend>
                        </div>
                    </div>
                    <div class="row-fluid">
                        <div class="span6">
                            <div class="control-group">
                                <label class="control-label">UZI-nummer</label>
                                <div class="controls">
                                    <input class="input-medium" type="text" wicket:id="uzinummer">
                                </div>
                            </div>
                        </div>

                    </div>
                </fieldset>
                <fieldset>
                    <div class="row-fluid">
                        <div class="span12">
                            <legend>Patholoog id</legend>
                        </div>
                    </div>
                    <div class="row-fluid">
                        <div class="span6">
                            <div class="control-group">
                                <label class="control-label">Patholoog ID</label>
                                <div class="controls">
                                    <input class="input-mini" type="text" wicket:id="patholoogId">
                                </div>
                            </div>
                        </div>
                    </div>
                </fieldset>

                <fieldset wicket:id="yubi-container">
                    <div class="row-fluid">
                        <div class="span12">
                            <legend>Yubikey</legend>
                        </div>
                    </div>
                    <div class="row-fluid">
                        <div class="span6">
                            <div class="control-group">
                                <label class="control-label">Private identity</label>
                                <div class="controls">
                                    <input class="input-medium" type="password"
                                           wicket:id="privateYubiIdentity">
                                </div>
                            </div>
                        </div>
                        <div class="span6">
                            <div class="control-group">
                                <label class="control-label">Secret key</label>
                                <div class="controls">
                                    <input class="input-medium" type="text"
                                           wicket:id="yubiKey.secretKey">
                                </div>
                            </div>
                        </div>
                    </div>
                </fieldset>

                <div class="row-fluid">
                    <div class="span12">
                        <div class="form-actions btn-bottom">
                            <button wicket:id="inActiveren" class="btn">
                                <i class="icon-minus-sign"></i> <span
                                    wicket:id="inActiverenTitle">Verwijderen</span>
                            </button>
                            <button wicket:id="annuleren" class="btn">Annuleren</button>
                            <button wicket:id="opslaan" class="btn btn-primary">Opslaan</button>
                        </div>
                    </div>
                </div>
            </form>
        </fieldset>
    </div>
</wicket:extend>
</html>
